Photography by Gabriel R.
"The 150,000 or so Palestinians living in Area C are all considered vulnerable communities. They suffer from many problems; poverty and unemployment rates are high and they lack essential services including those related to health care, that is why the Palestinian Medical Relief Society (PMRS) decided to focus its services on this area," explained Dr Mohammad Iskafi, the leading coordinator for the emergency program at PMRS, in an interview with the Palestine Monitor.

Founded in 1979 by a group of Palestinian doctors and health professionals, PMRS is now one of the largest health NGOs in the occupied Palestinian territories, providing medical, psychosocial and health education services throughout the West Bank and the Gaza Strip. The organization and its workers strive to address mental and physical health issues that are inadequately addressed, and often entirely disregarded, in many communities due to Israel’s occupation.

"Children and their families suffer a lot on a daily basis from recurrent violations from settlers and soldiers. When they have no access to a larger village or a school it is worse, they are completely cut off," explained Dr Iskafi, adding that such factors lead to psychological issues which also need to be addressed.

First Aid education is provided wherever possible in order to teach people basic life saving skills in case they are needed when there is no immediate access to a clinic. After the Second Intifada, PMRS started to provide mobile clinic services in order to alleviate the problems caused by restricted mobility and economic difficulty. Mobile clinic teams provide free consultations and medication to rural, and often physically separated (due to the geography of Israel’s occupation),communities, thus also preventing and minimizing the development of medical complications.

"3% of the people in the areas visited by our mobile clinics suffer from disability, many others have acute infections," said Mr Iskafi, "but the majority of cases we meet are those of chronic diseases such as diabetes, hypertension and heart diseases."

While accompanying the PMRS Mobile Clinic to various Bedouin communities and villages around Ramallah and the Jordan Valley, the Palestine Monitor met with families and patients who talked about their living conditions and their concern about the lack of access to medical or health services, especially at night. "My son was sick during the night," said a villager from Zbedat,in the Jordan Valley, "I could do nothing for him, there are no clinics here, we had to wait for the mobile clinic." He continued to explain that a few hours' visit once a week, though indeed a blessing for which they are thankful, is still not enough. "We wish that they could come every day," he said.

In many cases people have died because they did not get treatment in time.

Despite all its efforts at providing access to free consultations and medication, it is difficult for PMRS to cope with all the health necessities in Area C, the 60% or so of the West Bank under full Israeli civil and military control, even when there are also other organizations working there. As Mr. Iskafi relates, "it is not easy," since PMRS has to work within a budget that covers the doctors' salaries, transportation, blood tests and medication, as well as the obligatory purchase of a number of Israeli-granted entry permits for areas such as Arab Ramadin in Qalqilya and Barta'a in Jenin. Budget issues continually reduce certain possibilities. Without a permit, PMRS is barred access to the community in question. Dr Iskafi explained that presently, PMRS has "to cover at least 8-12 areas per one mobile clinic per month," thus making it difficult to go to the same area more often.

"In many cases people have died because they did not get treatment in time," said Suhad Hashem Shraim, a PMRS employee in Qalqilya, talking at length to the Palestine Monitor about the numerous problems faced by the people living between the Separation Wall and the Green Line in an area known as the Seam Zone. Ms Shraim highlighted circumstances in the region, stating that it is usually unlikely that patients with critically urgent conditions are rescued. If they manage to acquire a car or an ambulance, they are still stopped at checkpoints. She explained that over the years Israeli forces have frequently delayed ambulances for various hours as they tried to go through the entrance of Qalqilya. As a result many pregnant women end up dying from complications such as severe internal bleeding whilst giving birth in the ambulance.

In the Hebron area and the Jordan Valley, mobile clinics encounter health problems such as Ameoba, intestinal infections and Giardia which are caused by the lack or contamination of water. "The people living there are poor, they cannot afford fresh water all the time, many times they cannot afford fuel or gas to boil the water either," said Dr Iskafi.

A villager from Fasayel in the Jordan Valley, whose family are Bedouin refugees from Ein Gedi now located in present-day Israel, told the Palestine Monitor that he requires operations he is unable to afford. "I was very sick one day, and Israeli forces came and to demolish my son's home, I tried to stop them, I tried to talk to them, but on top of all that I was very weak. What can I do..." he said. He and his wife talk calmly and yet they acknowledge a deep sense of helplessness, "we cannot do anything, we cannot go anywhere, and we have very little money," they said, adding that they are able to eat only very little each day. Some of their goats were killed during the demolition. Their sons struggle between working and paying for their studies. Their daughter in law, who was pregnant when the Israeli forces came to demolish the house, tried to stand in front of the building along with other members of the family in order to prevent them from demolishing it, but she and her family were all beaten by the Israeli forces and were subsequently evacuated to a nearby hospital. Thankfully the baby was not injured and a new girl has now been added to the family, but their joy is overshadowed with shock and constant worry. It is hard to focus on medical attention whilst fighting all the other battles at hand.

Since Palestinians in Area C are prevented from building anything by the Israeli authority, PMRS cannot construct any form of clinic or pharmacy in remote areas, thus many residents in the area are completely dependent on mobile clinics.

Dr. Manar Fawadleh, a PMRS employee working with the Mobile clinic in the Ramallah area, explained that recently they have been providing basic gynecological services, especially to pregnant women who have no means of accessing a hospital before the actual birth of the child. "They are still referred to a hospital when they are about to have the baby, but at least they are able to have a gynecologist helping them during their pregnancy and many Bedouin women are glad about this," Dr. Fawadleh said.

"I wish for peace," said Dr Iskafi, "peace will solve all our problems, without it there is no life, no freedom." After 25 years of service with PMRS he still works hard, as do all other employees and volunteers. Their energy and dedication are strong each morning and does not evaporate by night despite the difficult conditions they meet during the day. They are, in fact, stronger and recharged for the next day. "I am sad to see the conditions they live in," says Dr Fawadleh, "but I am glad to be able to help."

"By going to these communities we are supporting the resilience of these people and encouraging them to stay in their homes, in their land," said Dr Iskafi, referring also to the fact that other organizations contribute to this by providing services of agriculture and education. This is a collective effort aimed at aiding the Palestinians in Area C, as well as other regions with health service complications, such as Qalqilya and East Jerusalem, who live in a form of limbo between walls, lines and fences, giving birth, drinking tea, working, studying, holding on to dear life between one restriction and another.

"When my mother had a heart attack the doctors told us she could not be treated at the UNRWA hospital and had to be taken to a hospital in Nablus which (sic) had more appropriate facilities for her case. Normally such a journey would have taken half an hour," said Ms Shraim "but due to the number of checkpoints it would have taken more than an hour, so the doctors preferred not to take the risk of her getting more complications on the way." Either way, her mother died one week later and she is convinced that had it not been for the complications caused by the Israeli authority, her mother might have had a much better chance of survival. "My mother is only one case, one example," she said, "there are many more sad cases..."

The list of cases goes ever on. Yet so too does the continuous effort of organizations such as PMRS along with their committed volunteers. As long as the need exists, they will keep providing and improving their services and support, acting as bastion of courage and strength for the Bedouins who are unable bear their burden alone.